Democratic Alliance leader Helen Zille has a new approach to fighting AIDS. Impatient with the pace of government and NGO efforts, she now advocates a program of forced testing and criminal prosecution for those who knowingly transmit the virus.
As AIDS experts have emphasized for decades, this won't work, and will almost certainly make things worse. In her article, Ms Zille favorably cites my book The Invisible Cure: Why we are Losing the Fight Against AIDS in Africa (Picador 2008) as evidence for her position. But the programs I call for in that book, and now, are precisely the opposite of Zille's.
In the book, I cite the examples of countries such as Uganda, Rwanda and the US where HIV rates had fallen, and Botswana and South Africa where (at the time of publication, at least) they had not. The policies in the successful countries involved not coercion, but openness and compassion. I don't even mention mandatory testing and disclosure, or criminalization of transmission. These are human rights abuses and must be totally off the menu.
Invisible Cure does argue that concurrent or overlapping partnerships are a major driver of the epidemic in Southern Africa. But it also presents evidence that the people of this region are neither especially "promiscuous" nor irresponsible in their sexual behavior. In fact, well-conducted surveys show that over a lifetime, Americans have more partners over a lifetime than people in Africa do. So why are HIV rates so much higher in Eastern and Southern Africa than in America?
Probably because people in East and Southern Africa are more likely to have a small number-perhaps two or three, ongoing partnerships at a time, which may overlap for months or years. Americans, on the other hand, tend to be "serially monogamous", running through many more partners one after another. Even though the Africans end up with fewer partners in the long run, they are at greater risk because the networks of concurrent partnerships serve as a kind of "superhighway" for HIV. By switching from partner to partner, Americans largely avoid becoming trapped in such networks.
As Ms/ Zille indicates, Invisible Cure also argues that behavioral change, particularly partner reduction is crucial to bringing HIV rates down. But "partner reduction" is very difference from abstinence, or perfect monogamy and it cannot be coerced. Rather, it's a negotiated adjustment that must make sense within a particular culture. The greatest obstacle to making such adjustments are shame and denial, which inhibit open discussion of sexuality, relationships and risk.